Bedwetting

While Dr Google can provide us with endless answers to our late night searches, it can be a minefield. Ironically we also 'googled' the top 10 questions that parents put into the search bar and over the next 10 weeks we are going to provide answers to them, from the perspective of our GPs, Psychologists, Nurses and our Allied Health team.

First up is bedwetting, with information kindly provided by our Clinical Psychologist Rhiannon. We hope this helps answer your questions.

Bedwetting

In a nutshell…it’s complicated. I know this sounds evasive, but let me explain. This is one of those times that Dr Google could lead you astray because of the complexity of the issue. Bedwetting, or enuresis which is the fancy word for it, is more common than some realise. It affects about 20% of 5-year-olds, 10% of 10-year-olds and 3% of 15-year-olds. An Australian study found that 19% of children aged 5-12 years sometimes wet the bed.

What can muddy the waters is that there are a range of potential causes for enuresis. What Google can’t do is ask you a series of questions, the answers to which would lead you down a very different treatment path. For instance, important questions include: How old is your child? Have they previously had bladder control and regressed, or is this an ongoing issue? Does your child have any other signs or symptoms that might indicate a physical illness? Is the issue only at night-time or are there daytime “accidents” as well? Have there been any recent changes or stressors? 

Uncovering the underlying cause as developmental, physical, or psychological (or a combination of these) will lead you to a different health professional and management plan. The best starting point, if bedwetting is a concern for you, is your GP. They will ask you the necessary questions and then help put a plan in place ranging potentially from a script to treat an infection, to referrals to a Paediatrician or a Psychologist. Or they may advise you that this is normal behaviour for your child’s age. 

No matter the underlying cause though, it is extremely important that children are not made to feel “bad” or “naughty” for wetting the bed. Speaking from experience, I know how unpleasant it is to change soggy sheets and air smelly mattresses, especially in the middle of the night. No child has ever done better from a place of shame, so take a deep breath and work through that frustration. Until you understand the problem, take preventative measures to protect the mattress and reassure your child that you will work through this together… and make that GP appointment.

But let’s say you’ve taken your child to the doctor and physical causes have been ruled out. If they are aged 7 or older, and the bedwetting is creating anxiety for your child, affecting their self-esteem, and / or preventing them from doing activities they would like to do (such as, school camp), you and your child may be referred to someone like me… a psychologist. So then, what can you expect?

First, is a comprehensive psychological assessment. Typically, children learn to control urination following three stages: 1) bowel control during sleep, 2) bladder and bowel control during wakefulness, and 3) control of the bladder at night. Enuresis can indicate a difficulty in meeting these stages. The psychologist will explore potential emotional causes such as parental conflict or divorce, school-based stressors, and significant loss, or changes (e.g., death of a grandparent, moving town). If an underlying stressor is identified, psychological intervention will be targeted at helping to resolve or reduce the impacts of this stressor.

Second, psychological treatment of bedwetting may also involve a behavioural component to support the child to become aware of the body cues which signal the need to urinate. Essentially, the goal is to build and strengthen the neural pathways that support the brain – bladder connection through awareness and repetition. To facilitate this, a specialised alarm system can be fitted to the child’s bed called the Bell and Pad system. These alarm systems are now considered first-line treatment for enuresis with research demonstrating an effectiveness rate of approximately 66%, and in some studies, up to 80%. The Bell and Pad system is just as it sounds. A rubber mat is placed in the bed connected to an alarm by a wire. When the child starts to wet the bed, a loud alarm sounds waking the child, which gives them the opportunity to stop, hold and go to the bathroom to complete the wee. Once a child has 14 dry nights in a row, then you can leave the mat off the bed altogether. Those mind-body pathways have been established and the child learns to wake up and go to the toilet before they wet the bed, or they learn to hold on all night. This process can take six to eight weeks to work. 

So as not to interfere with the opportunity for this pathway to develop, it is important the parent does not unintentionally undermine opportunities by taking the child to the toilet after they’ve gone to bed. Similarly, it is not helpful to restrict liquids, as the child needs to become used to the sensation of having a full bladder. In combination with the bed-time alarm system, day-time strategies can then be taught that further help them gain control over their bladder. The child learns they are the “boss” of their bladder and they can indeed control it with their minds.  

Given this is a skill the brain is learning, there will be “accidents” along the way. The parent will be encouraged to externalise the problem and not to blame the child or punish them. Treatment for enuresis is available and effective. It sometimes requires the help of certain specialists, but most importantly, it requires a positive and supportive approach from the family.